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Meng W, Yang C, Wei X, Wang S, Kang F, Huang X, Li J. Type of anesthesia and quality of recovery in male patients undergoing lumbar surgery: a randomized trial comparing propofol-remifentanil total i.v. anesthesia with sevoflurane anesthesia. BMC Anesthesiol 2021; 21:300. [PMID: 34852781 PMCID: PMC8638110 DOI: 10.1186/s12871-021-01519-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have shown that women achieve a better quality of postoperative recovery from total intravenous anesthesia (TIVA) than from inhalation anesthesia, but the effect of anesthesia type on recovery in male patients is unclear. This study therefore compared patient recovery between males undergoing lumbar surgery who received TIVA and those who received sevoflurane anesthesia. Methods Eighty male patients undergoing elective one- or two-level primary transforaminal lumbar interbody fusion (TLIF) were randomly divided into two groups: the TIVA group (maintenance was achieved with propofol and remifentanil) or sevoflurane group (SEVO group: maintenance was achieved with sevoflurane and remifentanil). The quality of recovery-40 questionnaire (QoR-40) was administered before surgery and on postoperative days 1 and 2 (POD1 and POD2). Pain scores, postoperative nausea and vomiting, postoperative hospital stay, anesthesia consumption, and adverse effects were recorded. Results The QoR-40 scores were similar on the three points (Preoperative, POD1 and POD2). Pain scores were significantly lower in the SEVO group than in the TIVA group on POD1 (30.6 vs 31.4; P = 0.01) and POD2 (32 vs 33; P = 0.002). There was no significant difference in the postoperative hospital stay or complications in the postanesthesia care unit between the TIVA group and the SEVO group. Conclusions This study demonstrates that the quality of recovery is not significantly different between male TLIF surgery patients who receive TIVA and those who receive sevoflurane anesthesia. Patients in the TIVA group had better postoperative analgesic effect on POD2. Trial registration This was registered at http://www.chictr.org.cn (registration number ChiCTR-IOR-16007987, registration date: 24/02/2016). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01519-y.
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Affiliation(s)
- Wenjun Meng
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China
| | - Chengwei Yang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China
| | - Xin Wei
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China
| | - Sheng Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China
| | - Xiang Huang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China
| | - Juan Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China.
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Lin WL, Lee MS, Wong CS, Chan SM, Lai HC, Wu ZF, Lu CH. Effects of intraoperative propofol-based total intravenous anesthesia on postoperative pain in spine surgery: Comparison with desflurane anesthesia - a randomised trial. Medicine (Baltimore) 2019; 98:e15074. [PMID: 30921241 PMCID: PMC6456101 DOI: 10.1097/md.0000000000015074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As reported, patients experience less postoperative pain after propofol-based total intravenous anesthesia (TIVA). In the present study, we investigated the postoperative analgesic effects between propofol-based TIVA and desflurane anesthesia after spine surgery. METHODS Sixty patients were included who received (surgical time >180 minutes) lumbar spine surgery. Patients were randomly assigned to receive either TIVA (with target-controlled infusion) with propofol/fentanyl-based anesthesia (TIVA group) or desflurane/fentanyl-based anesthesia (DES group), titrated to maintain Bispectral Index values between 45 and 55. All patients received patient-controlled analgesia (PCA) with fentanyl for postoperative pain relief. Numeric pain rating scale (NRS) pain scores, postoperative fentanyl consumption, postoperative rescue tramadol use, and fentanyl-related side effects were recorded. RESULTS The TIVA group patients reported lower NRS pain scores during coughing on postoperative day 1 but not day 2 and 3 (P = .002, P = .133, P = .161, respectively). Less fentanyl consumption was observed on postoperative days 1 and 2, but not on day 3 (375 μg vs 485 μg, P = .032, 414 μg vs 572 μg, P = .033, and 421 μg vs 479 μg, P = .209, respectively), less cumulative fentanyl consumption at postoperative 48 hours (790 μg vs 1057 μg, P = .004) and 72 hours (1210 μg vs 1536 μg, P = .004), and total fentanyl consumption (1393 μg vs 1704 μg, P = .007) when compared with the DES group. No difference was found in rescue tramadol use and fentanyl-related side effects. CONCLUSION Patients anesthetized with propofol-based TIVA reported less pain during coughing and consumed less daily and total PCA fentanyl after lumbar spine surgery.
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Affiliation(s)
- Wei-Lin Lin
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | | | - Chih-Shung Wong
- Department of Anesthesiology, Cathay General Hospital, Taipei
| | - Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan, Republic of China
| | - Chueng-He Lu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
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Inhibition by general anesthetic propofol of compound action potentials in the frog sciatic nerve and its chemical structure. Naunyn Schmiedebergs Arch Pharmacol 2018; 392:359-369. [PMID: 30519707 DOI: 10.1007/s00210-018-01596-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023]
Abstract
Although the intravenous general anesthetic propofol (2,6-diisopropylphenol) has an ability to inhibit nerve conduction, this has not been fully examined. Various agents inhibit compound action potentials (CAPs) in a manner dependent on their chemical structures. To determine propofol's chemical structure that is important in nerve conduction inhibition, we examined the effects of propofol and its related compounds on fast-conducting CAPs recorded from the frog sciatic nerve by using the air-gap method. Propofol concentration-dependently reduced the peak amplitude of the CAP with a half-maximal inhibitory concentration (IC50) value of 0.14 mM. A similar inhibition was produced by other phenols, 4-sec-butylphenol and 4-amylphenol (IC50 values: 0.33 and 0.20 mM, respectively). IC50 values for these and more phenols (4-isopropylphenol, 4-tert-butylphenol, and 4-ter-amylphenol; data published previously) were correlated with the logarithm of their octanol-water partition coefficients. A phenol having ketone group (raspberry ketone) and alcohols (3-phenyl-1-propanol and 2-phenylethylalcohol) inhibited CAPs less effectively than the above-mentioned phenols. The local anesthetic (LA) benzocaine reduced CAP peak amplitudes with an IC50 of 0.80 mM, a value larger than that of propofol. When compared with other LAs, propofol activity was close to those of ropivacaine, levobupivacaine, and pramoxine, while benzocaine activity was similar to those of cocaine and lidocaine. It is concluded that propofol inhibits nerve conduction, possibly owing to isopropyl and hydroxyl groups bound to the benzene ring of propofol and to its lipophilicity; propofol's efficacy is comparable to those of some LAs. These results could serve to develop propofol-related agents exhibiting analgesia when applied topically.
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Jia N, Zuo X, Guo C, Li Y, Cui J, Zhao C, Cao S, Wang C, Li R, Wu Y, Wen A. Synergistic antinociceptive effects of alfentanil and propofol in the formalin test. Mol Med Rep 2017; 15:1893-1899. [DOI: 10.3892/mmr.2017.6174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/02/2016] [Indexed: 11/05/2022] Open
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Opioid use after propofol or sevoflurane anesthesia: a randomized trial. Can J Anaesth 2016; 63:1258-65. [DOI: 10.1007/s12630-016-0728-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022] Open
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Miller TE, Gan TJ. Total Intravenous Anesthesia and Anesthetic Outcomes. J Cardiothorac Vasc Anesth 2015; 29 Suppl 1:S11-5. [DOI: 10.1053/j.jvca.2015.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/11/2022]
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Li L, Luo R, Fan P, Guo Y, Wang HS, Ma SJ, Zhao Y. Role of peripheral purinoceptors in the development of bee venom-induced nociception: a behavioural and electrophysiological study in rats. Clin Exp Pharmacol Physiol 2014; 41:902-10. [PMID: 25115823 DOI: 10.1111/1440-1681.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/18/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022]
Abstract
Colocalization of purinergic P2X and P2Y receptors in dorsal root ganglion sensory neurons implies that these receptors play an integrative role in the nociceptive transmission process under inflammatory conditions. In the present study, behavioural and in vivo electrophysiological methods were used to examine the peripheral role of P2 receptors in the persistent nociceptive responses induced by subcutaneous bee venom injection (2 mg/mL) in. Sprague-Dawley rats Local pretreatment with the wide-spectrum P2 receptor antagonist pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid (PPADS; 1 mmol/L, 50 μL) 10 min prior to s.c. bee venom injection significantly suppressed the duration of spontaneous nociceptive lifting/licking behaviour, inhibited mechanical hyperalgesia and decreased the firing of spinal dorsal horn wide dynamic range neurons in response to bee venom, without affecting primary thermal and mirror-image hyperalgesia. The localized antinociceptive action of PPADS was not due to a systemic effect, because application of the same dose of PPADS to the contralateral side was not effective. The results suggest that activation of peripheral P2 receptors is involved in the induction of nociceptive responses, mechanical hyperalgesia and the excitation of sensory spinal neurons.
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Affiliation(s)
- Li Li
- Department of Physiology and Pathophysiology, School of Medicine, Xi'an Jiaotong University Health Science Center, Xi'an, China
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The inhibitory effect of somatostatin receptor activation on bee venom-evoked nociceptive behavior and pCREB expression in rats. BIOMED RESEARCH INTERNATIONAL 2014; 2014:251785. [PMID: 24895558 PMCID: PMC4033427 DOI: 10.1155/2014/251785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/31/2014] [Accepted: 04/14/2014] [Indexed: 12/27/2022]
Abstract
The present study examined nociceptive behaviors and the expression of phosphorylated cAMP response element-binding protein (pCREB) in the dorsal horn of the lumbar spinal cord and the dorsal root ganglion (DRG) evoked by bee venom (BV). The effect of intraplantar preapplication of the somatostatin analog octreotide on nociceptive behaviors and pCREB expression was also examined. Subcutaneous injection of BV into the rat unilateral hindpaw pad induced significant spontaneous nociceptive behaviors, primary mechanical allodynia, primary thermal hyperalgesia, and mirror-thermal hyperalgesia, as well as an increase in pCREB expression in the lumbar spinal dorsal horn and DRG. Octreotide pretreatment significantly attenuated the BV-induced lifting/licking response and mechanical allodynia. Local injection of octreotide also significantly reduced pCREB expression in the lumbar spinal dorsal horn and DRG. Furthermore, pretreatment with cyclosomatostatin, a somatostatin receptor antagonist, reversed the octreotide-induced inhibition of the lifting/licking response, mechanical allodynia, and the expression of pCREB. These results suggest that BV can induce nociceptive responses and somatostatin receptors are involved in mediating the antinociception, which provides new evidence for peripheral analgesic action of somatostatin in an inflammatory pain state.
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Spinal changes of a newly isolated neuropeptide endomorphin-2 concomitant with vincristine-induced allodynia. PLoS One 2014; 9:e89583. [PMID: 24586889 PMCID: PMC3933549 DOI: 10.1371/journal.pone.0089583] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/21/2014] [Indexed: 12/01/2022] Open
Abstract
Chemotherapy-induced neuropathic pain (CNP) is the major dose-limiting factor in cancer chemotherapy. However, the neural mechanisms underlying CNP remain unclear. There is increasing evidence implicating the involvement of spinal endomorphin-2 (EM2) in neuropathic pain. In this study, we used a vincristine-evoked rat CNP model displaying mechanical allodynia and central sensitization, and observed a significant decrease in the expression of spinal EM2 in CNP. Also, while intrathecal administration of exogenous EM2 attenuated allodynia and central sensitization, the mu-opioid receptor antagonist β-funaltrexamine facilitated these events. We found that the reduction in spinal EM2 was mediated by increased activity of dipeptidylpeptidase IV, possibly as a consequence of chemotherapy-induced oxidative stress. Taken together, our findings suggest that a decrease in spinal EM2 expression causes the loss of endogenous analgesia and leads to enhanced pain sensation in CNP.
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Ji W, Cui C, Zhang Z, Liang J. Paradoxic effects of propofol on visceral pain induced by various TRPV1 agonists. Exp Ther Med 2013; 5:1259-1263. [PMID: 23596498 PMCID: PMC3628225 DOI: 10.3892/etm.2013.950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/01/2013] [Indexed: 11/29/2022] Open
Abstract
Intraperitoneal injection of propofol inhibits subsequent acetic acid-induced writhing response in mice. Propofol increases the sensitivity of dorsal root ganglion neurons to capsaicin through transient receptor potential ankyrin subtype-1 (TRPA1) and protein kinase Cε (PKCε)-mediated phosphorylation of transient receptor potential vanilloid subtype-1 (TRPV1). Intraperitoneal co-injection of propofol may increase visceral nociception induced by TRPV1 agonists via sensitization of TRPV1. Therefore, we investigated the effects of intraperitoneal co-injection of propofol on nociception induced by acetic acid and capsaicin. The number of writhing movements induced by acetic acid or nociception time by capsaicin with or without propofol were counted. Neonatal capsaicin-treated mice were also used to demonstrate the role of TRPV1 in the effects of propofol on nociception, induced by TRPV1 agonists. Co-injection of propofol resulted in a pronociceptive effect on the writhing response induced by acetic acid, while the same dose of propofol ameliorated the response to capsaicin. The writhing response to intraperitoneal acetic acid was sharply inhibited following neonatal treatment with capsaicin. Co-injection with propofol reduced the number of writhing movements induced by acetic acid in neonatal capsaicin-treated mice. These results suggest that propofol binds to TRPV1 at the capsaicin-binding pocket.
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Affiliation(s)
- Wenjin Ji
- Postgraduate Institute, Southern Medical University, Guangzhou 510015; ; Departments of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China
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Tibbs GR, Rowley TJ, Sanford RL, Herold KF, Proekt A, Hemmings HC, Andersen OS, Goldstein PA, Flood PD. HCN1 channels as targets for anesthetic and nonanesthetic propofol analogs in the amelioration of mechanical and thermal hyperalgesia in a mouse model of neuropathic pain. J Pharmacol Exp Ther 2013; 345:363-73. [PMID: 23549867 DOI: 10.1124/jpet.113.203620] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Chronic pain after peripheral nerve injury is associated with afferent hyperexcitability and upregulation of hyperpolarization-activated, cyclic nucleotide-regulated (HCN)-mediated IH pacemaker currents in sensory neurons. HCN channels thus constitute an attractive target for treating chronic pain. HCN channels are ubiquitously expressed; analgesics targeting HCN1-rich cells in the peripheral nervous system must spare the cardiac pacemaker current (carried mostly by HCN2 and HCN4) and the central nervous system (where all four isoforms are expressed). The alkylphenol general anesthetic propofol (2,6-di-iso-propylphenol) selectively inhibits HCN1 channels versus HCN2-HCN4 and exhibits a modest pharmacokinetic preference for the periphery. Consequently, we hypothesized that propofol, and congeners, should be antihyperalgesic. Alkyl-substituted propofol analogs have different rank-order potencies with respect to HCN1 inhibition, GABA(A) receptor (GABA(A)-R) potentiation, and general anesthesia. Thus, 2,6- and 2,4-di-tertbutylphenol (2,6- and 2,4-DTBP, respectively) are more potent HCN1 antagonists than propofol, whereas 2,6- and 2,4-di-sec-butylphenol (2,6- and 2,4-DSBP, respectively) are less potent. In contrast, DSBPs, but not DTBPs, enhance GABA(A)-R function and are general anesthetics. 2,6-DTBP retained propofol's selectivity for HCN1 over HCN2-HCN4. In a peripheral nerve ligation model of neuropathic pain, 2,6-DTBP and subhypnotic propofol are antihyperalgesic. The findings are consistent with these alkylphenols exerting analgesia via non-GABA(A)-R targets and suggest that antagonism of central HCN1 channels may be of limited importance to general anesthesia. Alkylphenols are hydrophobic, and thus potential modifiers of lipid bilayers, but their effects on HCN channels are due to direct drug-channel interactions because they have little bilayer-modifying effect at therapeutic concentrations. The alkylphenol antihyperalgesic target may be HCN1 channels in the damaged peripheral nervous system.
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Affiliation(s)
- Gareth R Tibbs
- Department of Anesthesiology, College of Physicians & Surgeons, Columbia University, New York, New York, USA
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Hasani A, Gecaj-Gashi A, Llullaku S, Jashari H. Postoperative Analgesia in Children After Propofol Versus Sevoflurane Anesthesia. PAIN MEDICINE 2013; 14:442-6. [DOI: 10.1111/pme.12031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Takechi K, Carstens MI, Klein AH, Carstens E. The antinociceptive and antihyperalgesic effects of topical propofol on dorsal horn neurons in the rat. Anesth Analg 2013; 116:932-8. [PMID: 23337417 DOI: 10.1213/ane.0b013e31827f560d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Propofol (2,6-diisopropylphenol) is an IV anesthetic used for general anesthesia. Recent evidence suggests that propofol-anesthetized patients experience less postoperative pain, and that propofol has analgesic properties when applied topically. We presently investigated the antinociceptive effects of topical propofol using behavioral and single-unit electrophysiological methods in rats. METHODS In behavioral experiments with rats, we assessed the effect of topical hindpaw application of propofol (1%-25%) on heat and mechanically evoked paw withdrawals. In electrophysiological experiments, we recorded from lumbar dorsal horn wide dynamic range (WDR)-type neurons in pentobarbital-anesthetized rats. We assessed the effect of topical application of propofol to the ipsilateral hindpaw on neuronal responses elicited by noxious heat, cold, and mechanical stimuli. We additionally tested whether propofol blocks heat sensitization of paw withdrawals and WDR neuronal responses induced by topical application of allyl isothiocyanate (AITC; mustard oil). RESULTS Topical application of propofol (1%-25%) significantly increased the mean latency of the thermally evoked hindpaw withdrawal reflex on the treated (but not opposite) side in a concentration-dependent manner, with no effect on mechanically evoked hindpaw withdrawal thresholds. Propofol also prevented shortening of paw withdrawal latency induced by AITC. In electrophysiological experiments, topical application of 10% and 25% propofol, but not 1% propofol or vehicle (10% intralipid), to the ipsilateral hindpaw significantly attenuated the magnitude of responses of WDR neurons to noxious heating of glabrous hindpaw skin with no significant change in thermal thresholds. Maximal suppression of noxious heat-evoked responses was achieved 15 minutes after application followed by recovery to the pre-propofol baseline by 30 minutes. Responses to skin cooling or graded mechanical stimuli were not significantly affected by any concentration of propofol. Topical application of AITC enhanced the noxious heat-evoked response of dorsal horn neurons. This enhancement of heat-evoked responses was attenuated when 10% propofol was applied topically after application of AITC. CONCLUSIONS The results indicate that topical propofol inhibits responses of WDR neurons to noxious heat consistent with analgesia, and reduced AITC sensitization of WDR neurons consistent with an antihyperalgesic effect. These results are consistent with clinical studies demonstrating reduced postoperative pain in surgical patients anesthetized with propofol. The mechanism of analgesic action of topical propofol is not clear, but may involve desensitization of TRPV1 or TRPA1 receptors expressed in peripheral nociceptive nerve endings, engagement of endocannabinoids, or activation of peripheral γ-aminobutyric acid A receptors.
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Affiliation(s)
- Kenichi Takechi
- Department of Anesthesiology and Resuscitology, Ehime University Medical School, Matsuyama, Japan
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Song JG, Shin JW, Lee EH, Choi DK, Bang JY, Chin JH, Choi IC. Incidence of post-thoracotomy pain: a comparison between total intravenous anaesthesia and inhalation anaesthesia. Eur J Cardiothorac Surg 2012; 41:1078-82. [DOI: 10.1093/ejcts/ezr133] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yu HY, Mu DG, Chen J, Yin W. Suppressive Effects of Intrathecal Paeoniflorin on Bee Venom-Induced Pain-Related Behaviors and Spinal Neuronal Activation. Pharmacology 2011; 88:159-66. [DOI: 10.1159/000330456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 06/21/2011] [Indexed: 11/19/2022]
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Chen J, Lariviere WR. The nociceptive and anti-nociceptive effects of bee venom injection and therapy: a double-edged sword. Prog Neurobiol 2010; 92:151-83. [PMID: 20558236 DOI: 10.1016/j.pneurobio.2010.06.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 03/31/2010] [Accepted: 06/08/2010] [Indexed: 12/23/2022]
Abstract
Bee venom injection as a therapy, like many other complementary and alternative medicine approaches, has been used for thousands of years to attempt to alleviate a range of diseases including arthritis. More recently, additional theraupeutic goals have been added to the list of diseases making this a critical time to evaluate the evidence for the beneficial and adverse effects of bee venom injection. Although reports of pain reduction (analgesic and antinociceptive) and anti-inflammatory effects of bee venom injection are accumulating in the literature, it is common knowledge that bee venom stings are painful and produce inflammation. In addition, a significant number of studies have been performed in the past decade highlighting that injection of bee venom and components of bee venom produce significant signs of pain or nociception, inflammation and many effects at multiple levels of immediate, acute and prolonged pain processes. This report reviews the extensive new data regarding the deleterious effects of bee venom injection in people and animals, our current understanding of the responsible underlying mechanisms and critical venom components, and provides a critical evaluation of reports of the beneficial effects of bee venom injection in people and animals and the proposed underlying mechanisms. Although further studies are required to make firm conclusions, therapeutic bee venom injection may be beneficial for some patients, but may also be harmful. This report highlights key patterns of results, critical shortcomings, and essential areas requiring further study.
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Affiliation(s)
- Jun Chen
- Institute for Biomedical Sciences of Pain and Institute for Functional Brain Disorders, Tangdu Hospital, The Fourth Military Medical University, 1 Xinsi Road, Baqiao District, Xi'an 710038, PR China.
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Median effective infusion dose (ED50) of alfentanil for monitored anesthesia care of percutaneous vertebroplasty of osteoporotic fractures. J Neurosurg Anesthesiol 2009; 21:165-9. [PMID: 19295397 DOI: 10.1097/ana.0b013e3181920d3b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Percutaneous vertebroplasty (PVP) consists of injecting small quantities of orthopedic cement to consolidate pathologic vertebral bodies. The procedure is brief but painful during vertebral puncture and cement injection requiring either general anesthesia or monitored anesthesia care with opioids. The optimal dose of alfentanil in this setting is unknown. Therefore, we sought to determine its median effective dose (ED50, or analgesic efficacy in 50% of patients) during PVP in none intubated, spontaneously breathing patients. After approval and informed consent of the Institutional Review Board, 50 patients (American Society of Anesthesiologists II-III, age 50 to 80, weight: 53 to 82 kg) with osteoporotic vertebral fractures were enrolled. The patients were premedicated with oral hydroxyzine 100 mg and had skin infiltration with 50 mg lidocaine before vertebral puncture. The prone position was adopted and oxygen was provided via a facemask. Noninvasive cardiorespiratory variables were monitored. Pain was evaluated by a numerical pain scale (NPS) where 0 represents no pain and 10 the worst tolerable pain. Alfentanil infusion was started 30 minutes before vertebral puncture. The initial dose was 2.0 mg/h. Thereafter, a 0.05 mg/h decrease or increase was applied to the next patient if analgesia was effective (NPS: 3 or less) or not (NPS>3) according to the Dixon method. The bootstrap resampling technique was used to calculate the ED50 and its 95% confidence limits. The latter was 1.05 mg/h (95% confidence interval, 1.0-1.2). Transient apnea (n=2) and nausea/vomiting (n=3) were observed. Given the median body weight of the patients (65 kg), we conclude that 0.27 microg kg/min of alfentanil provides effective analgesia for PVP under monitored anesthesia care. SUMMARY STATEMENT PVP consists of injecting small quantities of orthopedic cement to consolidate pathologic vertebral bodies. The median effective dose (ED50) for pain relief during vertebral puncture and cement injection is 1.05 (95% confidence interval, 1.0-1.2) mg/h when infusion is started 30 minutes before the procedure. Given the median body weight of our study population (65 kg), this dose corresponds to 0.27 microg kg/min.
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Yu YQ, Zhao F, Chen J. Activation of ERK1/2 in the primary injury site is required to maintain melittin-enhanced wind-up of rat spinal wide-dynamic-range neurons. Neurosci Lett 2009; 459:137-41. [PMID: 19427362 DOI: 10.1016/j.neulet.2009.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 04/10/2009] [Accepted: 05/04/2009] [Indexed: 01/07/2023]
Abstract
Peripheral modulation of wind-up enhancement induced by peripheral tissue injury is investigated in rat spinal wide-dynamic-range (WDR) neurons. After subcutaneous (s.c.) injection of melittin, a pain-related peptidergic component separated from bee venom, the responsiveness of spinal cord WDR neuron to repeated suprathreshold (1.5T, the intensity threshold) electrical stimuli is enhanced. Comparing with the less effects on early response (0-100 ms), melittin significantly increases late response (100 ms to the next stimulus artifact) and after-discharge (starting from 2s after the last stimulus artifact) with 189% and 546%, respectively. Peripheral administration of a specific MEK inhibitor, 1,4-diamino-2,3-dicyano-1,4-bis-[o-aminophenylmercapto] butadiene (U0126, 1 microg) gradually suppresses, but not completely blocks melittin-enhanced wind-up to the similar level of baseline. The inhibitions of U0126 are mainly on late response and after-discharge with 49% and 65%, respectively. Peripheral administration of three doses of U0126 (0.1, 1, 10 microg) has no effects on melittin-induced local paw edema regardless of either pre- or post-treatment of the drug. We conclude that peripheral ERKs pathway in the primary injury site is required to maintain melittin-enhanced wind-up of rat spinal cord wide-dynamic-range neurons.
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Affiliation(s)
- Yao-Qing Yu
- Institute for Biomedical Sciences of Pain and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, PR China
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Li MM, Yu YQ, Fu H, Xie F, Xu LX, Chen J. Extracellular signal-regulated kinases mediate melittin-induced hypersensitivity of spinal neurons to chemical and thermal but not mechanical stimuli. Brain Res Bull 2008; 77:227-32. [PMID: 18725270 DOI: 10.1016/j.brainresbull.2008.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 06/29/2008] [Accepted: 07/25/2008] [Indexed: 02/07/2023]
Abstract
Subcutaneous melittin injection causes central plasticity at the spinal level in wide-dynamic-range (WDR) neurons, which are hypersensitive to various nociceptive stimuli. Previous behavioral studies demonstrated that the mitogen-activated protein kinases (MAPKs) extracellular signal-regulated kinase 1/2(ERK1/2), p38 MAPK, and c-Jun N-terminal kinase are involved in both peripheral and spinal processing of melittin-induced nociception and hypersensitivity. Yet the functional roles of the three MAPKs vary among different stimulus modalities, and must be further studied at the cellular level in vivo. In this report, extracellular single unit recordings were performed to investigate whether activation of ERK1/2 in the primary injury site of melittin is essential to the establishment of a spinally sensitized state. Localized peripheral administration of a single dose of the MEK inhibitor U0126 (1 μg/10 μl) significantly suppressed neuronal hyper-responsiveness to thermal stimulus and chemical (melittin)-induced tonic firing of WDR neurons after full establishment of a spinally sensitized state. However, U0126 failed to affect mechanical hypersensitivity to both noxious and non-noxious stimuli. Melittin-induced enhancement of thermal hypersensitivity was also greatly inhibited by a single dose of capsazepine, a thermal nociceptor (TRPV1) blocker. These results suggest that activation of the ERK signaling pathway in the periphery is likely necessary for maintenance of a spinally sensitized state; activation of ERK1/2 in the primary injury site may regulate TRPV1, leading to dorsal horn hypersensitivity to thermal and chemical stimuli. ERK signaling pathways are not likely to be associated with melittin-induced dorsal horn hypersensitivity to mechanical stimuli.
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Affiliation(s)
- Meng-Meng Li
- Institute for Biomedical Sciences of Pain and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, #1 Xinsi Road, Baqiao, Xi'an 710038, PR China
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Hao J, Liu MG, Yu YQ, Cao FL, Li Z, Lu ZM, Chen J. Roles of peripheral mitogen-activated protein kinases in melittin-induced nociception and hyperalgesia. Neuroscience 2008; 152:1067-75. [PMID: 18329815 DOI: 10.1016/j.neuroscience.2007.12.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 12/12/2007] [Accepted: 12/27/2007] [Indexed: 12/30/2022]
Abstract
Recently, we have reported that melittin, a major toxic peptide of the whole bee venom, plays a central role in production of local inflammation, nociception and hyperalgesia following the experimental honeybee's sting. However, the exact peripheral mechanisms underlying melittin-induced multiple pain-related behaviors are still less characterized. In the present study, we sought to investigate the potential roles of peripheral mitogen-activated protein kinases (MAPKs) in melittin-induced nociception and hyperalgesia by pre- and post-administration of three MAPK inhibitors, namely U0126 (1 mug, 10 mug) for extracellular signal-regulated kinase (ERK), SP600125 (10 mug, 100 mug) for c-Jun N-terminal kinase (JNK) and SB239063 (10 mug, 100 mug) for p38 MAPK, into the local inflamed area of one hind paw of rats. Both pre- and post-treatment with three drugs significantly suppressed the occurrence and maintenance of melittin-evoked persistent spontaneous nociception (PSN) and primary heat hyperalgesia, with little antinociceptive effect on mechanical hyperalgesia. In vehicle-treated group, ipsilateral injection of melittin produced no impact on thermal and mechanical sensitivity of the other hind paw, suggesting no occurrence of contralateral heat and mechanical hyperalgesia in the melittin test. In addition, local administration of each inhibitor into the contralateral hind paw exerted no significant influence on either PSN or heat/mechanical hyperalgesia tested in the primary injured hind paw, excluding the systemically pharmacological effects of the three drugs. Furthermore, local administration of the three compounds in naïve animals, respectively, did not change the basal pain sensitivity to either thermal or mechanical stimuli, suggesting lack of peripherally functional roles of the three MAPK subfamily members in normal pain sensitivity under the physiological state. Taken together, we conclude that activation of peripheral MAPKs, including ERK, JNK and p38, might contribute to the induction and maintenance of persistent ongoing pain and primary heat hyperalgesia in the melittin test. However, they are not likely to be involved in the processing of melittin-induced primary mechanical hyperalgesia, implicating a mechanistic separation between mechanical and thermal hyperalgesia in the periphery.
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Affiliation(s)
- J Hao
- Institute for Biomedical Sciences of Pain and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, 1# Xinsi Road, Baqiao District, Xi'an 710038, PR China
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Cheng SS, Yeh J, Flood P. Anesthesia Matters: Patients Anesthetized with Propofol Have Less Postoperative Pain than Those Anesthetized with Isoflurane. Anesth Analg 2008; 106:264-9, table of contents. [DOI: 10.1213/01.ane.0000287653.77372.d9] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Guindon J, LoVerme J, Piomelli D, Beaulieu P. The Antinociceptive Effects of Local Injections of Propofol in Rats Are Mediated in Part by Cannabinoid CB1 and CB2 Receptors. Anesth Analg 2007; 104:1563-9, table of contents. [PMID: 17513659 DOI: 10.1213/01.ane.0000263278.05423.a3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Propofol can inhibit fatty acid amidohydrolase, the enzyme responsible for the metabolism of anandamide (an endocannabinoid). To study the potential antinociceptive effect of propofol, we administered different doses (0.005, 0.05, 0.5, 5, and 500 microg) of the anesthetic in the hind paw of animals to determine an ED50. To further investigate the mechanisms by which propofol produced its antinociceptive effect, we used specific antagonists for the cannabinoid CB1 (AM251) and CB2 (AM630) receptors and measured fatty-acid amide/endocannabinoid (anandamide, 2-arachidonylglycerol, and palmitoylethanolamide) concentrations in skin paw tissues. METHODS Formalin tests were performed on 65 Wistar rats allocated to six different groups: 1) control (Intralipidtrade mark 10%); 2) propofol (ED50 dose); 3) AM251; 4) AM251 + propofol; 5) AM630; 6) AM630 + propofol. Drugs were injected subcutaneously in the dorsal surface of the hind paw (50 microL) 15 min before 2.5% formalin injection into the same paw. Fatty-acid amide/endocannabinoid levels were measured by high performance liquid chromatography/mass spectrometry analysis. RESULTS Propofol produced a dose-dependent antinociceptive effect for the early and late phases of the formalin test with an ED50 of 0.08 +/- 0.061 microg for the latter phase. This effect was antagonized by AM251 and AM630. It was locally mediated, since a higher dose of propofol given in the contralateral paw was not antinociceptive. Finally, only paw concentrations of palmitoylethanolamide were significantly increased. CONCLUSION In a test of inflammatory pain, locally injected propofol decreased pain behavior in a dose-dependent manner. This antinociceptive effect was mediated, in part, by CB1 and CB2 receptors.
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Affiliation(s)
- Josée Guindon
- Department of Pharmacology, Faculty of Medicine, Université de Montréal-CHUM, Montréal, Québec, Canada
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Liljeroth E, Karlsson A, Lagerkranser M, Akeson J. Low-dose propofol reduces the incidence of moderate to severe local pain induced by the main dose. Acta Anaesthesiol Scand 2007; 51:460-3. [PMID: 17378785 DOI: 10.1111/j.1399-6576.2006.01255.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Local pain on injection of propofol remains a considerable problem in clinical anaesthesiology. As slow infusion of a low dose of propofol induces little or no pain at the site of injection, and as propofol-induced pain fades during prolonged exposure, this randomized, double-blind, clinical cross-over study was designed to test whether pain on injection of propofol is attenuated by initial slow injection of a low dose of propofol by the same intravenous line. METHODS Seventy-seven adult surgical patients were cannulated in a dorsal vein on each hand. In each cannula, a 0.5-ml priming dose of either propofol 10 mg/ml dissolved in an emulsion of medium- and long-chain triglycerides or aqueous sodium chloride 9.0 mg/ml was injected over 30 s, and followed 120 s later by a main dose of 2.0 ml of the same propofol formula over 6 s. After each injection, the patients were asked by a blind investigator to score the maximal pain intensity on a visual analogue scale (VAS). RESULTS Although the decrease in maximal pain intensity did not reach statistical significance (P= 0.070), significantly fewer patients reported moderate or severe pain intensity (corresponding to 3.0 VAS units or more) after the main dose of propofol was preceded by a priming dose of propofol than by sodium chloride (P= 0.041). CONCLUSIONS The incidence of moderate to severe local pain induced by intravenous propofol can be decreased by a readily applicable technique in which a low dose of propofol emulsion is slowly administered by the same intravenous route 2 min in advance.
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Affiliation(s)
- E Liljeroth
- Department of Anaesthesiology and Intensive Care Medicine, Karolinska Institute, Karolinska University Hospital Solna, Stockholm, Sweden
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